New York Codes, Rules and Regulations
Title 14 - DEPARTMENT OF MENTAL HYGIENE
Chapter XIII - Office of Mental Health
Part 512 - Personalized Recovery Oriented Services
Section 512.20 - Target population services
Universal Citation: 14 NY Comp Codes Rules and Regs ยง 512.20
Current through Register Vol. 46, No. 39, September 25, 2024
(a) Individuals who are target population members as defined in Section 512.4 of this Part must meet the standard eligibility criteria for enroll- ment in PROS in accordance with Section 512.7 of this Part.
(b) Effective April 1, 2014, the following additional provisions shall apply to PROS providers that are providing services to target population members.
(1) Reimbursement for services to target
population members who are in continuous pre-admission status is limited to
four consecutive months, whether or not the individual is ultimately admitted
to the program. Programs will be reimbursed for pre-admission services for
target population members at the existing pre-admission rate plus 25
percent.
(2) Medicaid may reimburse
the Intensive Rehabilitation (IR) component add-on for up to 50 percent of a
provider's total number of monthly base rate bills submitted annually. IR
services provided to target population members shall not count toward the 50
percent limitation for Medicaid reimbursement.
(3) The following Community Rehabilitation
and Support (CRS) services will offer an enhanced reimbursement when delivered
off site, on separate days, to target population members:
(i) Basic skills living training;
(ii) Benefits and financial
management;
(iii) Community living
exploration;
(iv) Information and
education regarding self help; and
(v) Wellness self management.
(4) If two or three of the
identified CRS services are delivered off site to target population members in
a calendar month, programs will be reimbursed at the base rate plus $135.33
(upstate) or $150.37 (downstate), effective April 1, 2015. If four or more of
the identified CRS services are delivered off site to target population members
in a calendar month, programs will be reimbursed at the base rate plus $270.67
(upstate) or $300.73 (downstate), effective April 1, 2015.
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